Dawaa Reference

Clinical reference

Endometriosis (referral & initial medical management)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ESHRE Guideline Endometriosis 2022 · NICE Guideline NG73 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis

Verified against3 documents
  • Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)
  • ESHRE Guideline Endometriosis 2022
  • Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Chronic cyclic pelvic pain, painful periods, painful sex, painful defecation, dysuria, and infertility are the hallmark symptoms, and severity does not track with how much disease is present [abdominal pain · burning on passing urine · infertility · painful periods · pelvic pain]
  • Neuropathic pain or allodynia can occur, especially with deep infiltrating disease near nerve fibers [burning pain · hyperalgesia]
  • Bowel or rectovaginal involvement can cause gastrointestinal symptoms or bleeding that follows the cycle, while superficial lesions can be silent [bleeding]
  • Pelvic pain affects most patients, and many also report significant fatigue [abdominal pain · fatigue · pelvic pain]

Signs — what you find (1)

  • Findings can include tenderness of the uterus or adnexa, an adnexal mass from an endometrioma, uterosacral nodularity, or limited uterine mobility [pelvic mass]

Tests (6)

  • Transvaginal ultrasound is the preferred first-line imaging test, especially for identifying endometriomas
  • Transvaginal ultrasound often misses superficial peritoneal lesions despite performing well for endometriomas
  • MRI is a secondary imaging test used mainly for surgical planning in deep endometriosis
  • Negative imaging does not rule out endometriosis, and treatment can proceed despite normal findings
  • Laparoscopy can confirm the diagnosis but is not required before starting medical treatment
  • Biopsy confirms suspicious lesions histologically, but a negative biopsy does not exclude endometriosis

If not this — what else fits (12)

  • Primary dysmenorrhea
  • Adenomyosis
  • Uterine fibroids
  • Pelvic inflammatory disease
  • Irritable bowel syndrome
  • Inflammatory bowel disease
  • Interstitial cystitis
  • Recurrent urinary tract infections
  • Pudendal neuralgia is on the differential
  • Ovarian cysts
  • Ectopic pregnancy and other early pregnancy problems need to be ruled out in women of reproductive age
  • Central sensitization and somatic symptom disorders are psychosocial factors that can mimic or worsen pelvic pain

SourceStatPearls "Endometriosis" - disease-level clinical article

Presentation findings are traced to the source above.

1

ETHINYL ESTRADIOL + LEVONORGESTREL

1st line

Formoral.solid

Adult dose and duration

30 mcg Ethinylestradiol + 150 mcg Levonorgestrel tablet taken once daily continuously (or cyclically 21 days on, 7 days off) - long-term

Paediatric dose

Post-menarcheal adolescents: 1 tablet daily

Dose source

ESHRE Guideline Endometriosis 2022

Why

Single-ingredient ethinylestradiol is not marketed in Egypt. This is the combined pill, and it is what suppresses the disease.

Cautions
  • Standalone ethinylestradiol single-ingredient tablets are unavailable in Egyptian pharmacies.
  • Contraindicated in women with history of VTE/PE, severe hypertension, focal migraine, or active liver disease.
  • There is an increased venous thromboembolism risk.
Egyptian brands
Egyptian brandManufacturerIndicative price
MICROCEPT 21 TAB.CID0.76 EGP (0.04/unit)
MICRODETTE 3* 21 TAB.EL NILE.7.50 EGP (0.36/unit)
NORDETTE 5*21 TAB.EL NILE. > PFIZER15.00 EGP (0.71/unit)
MICROGENEST 30/150 MCG 21 TABS.ACDIMA INTERNATIONAL TRADING23.00 EGP (1.10/unit)
TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC)CID120.00 EGP (5.71/unit)
2

MEDROXYPROGESTERONE ACETATE

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg 3 times daily orally continuously x 6-12 months

Paediatric dose

Specialist pediatric gynecology referral required

Dose source

Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis

Why

Progestin monotherapy for patients unable or unwilling to take combined estrogen therapy

Cautions
  • Weight gain, irregular breakthrough bleeding, and fluid retention are common.
  • Bone mineral density loss with prolonged use (>2 years); ensure adequate calcium/vitamin D intake.
  • The licensed course is 90 days, started on the first day of a period. Suppressing for six to twelve months is common practice but it is beyond what the label covers - know which one you are doing.
  • Egypt's only oral medroxyprogesterone, PROVERA 5 mg, is marked CANCELLED in the national register, so this 10 mg three-times-daily course cannot be dispensed as written. The medroxyprogesterone injections marketed here (DEPO-PROVERA 150 mg/mL, MEGESTRON, OXYPROGEST, SAYANA 104 mg/0.65 mL) are registered for contraception: the Egyptian National Drug Formulary gives the 150 mg every 3 months intramuscular dose under contraception, not under endometriosis. Consider dienogest or a combined oral contraceptive instead, or specialist referral.
Egyptian brands
Egyptian brandManufacturerIndicative price
PROVERA 5 MG 24 TABS.(CANCELLED)? strength differsdiscontinuedPFIZER24.00 EGP (1.00/unit)
3

NAPROXEN

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily with food during dysmenorrhea and pelvic pain flares x 3-5 days during menses

Paediatric dose

Adolescents with severe dysmenorrhea: 500 mg initial, then 250-500 mg BID with food

Dose source

Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)

Why

For the pain of a flare. It does not treat the endometriosis - give it alongside hormonal suppression, not instead of it.

Cautions
  • Does not suppress endometriotic lesion progression; combined hormonal therapy required for disease control.
  • There is a risk of GI distress and ulceration with chronic use.
Egyptian brands
Egyptian brandManufacturerIndicative price
ORGOPROXEN 500 MG 20 TAB.ORGANOPHARMA > ORGANO16.00 EGP (0.80/unit)
NAPROSYN 500 MG 10 TAB.MISR > F.HOFFMAN LA ROCHE8.05 EGP (0.81/unit)
NAPROFEN 500MG 10 TAB.EL NILE.12.00 EGP (1.20/unit)
NAPROFEN 500MG 20 TAB.EL NILE.24.00 EGP (1.20/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.